Background: The cost of hypertension healthcare services is increasing worldwide due to increase of its prevalence estimated to 40% in adults globally and high prevalence 46% is in Sub-Saharan African. The purpose of this study is to provide information of the cost of hypertension health care services in monetary values on one hand and to determine the cost of health care services of each stage of hypertension at district hospital in rural Rwanda. The study benefits the care givers of hypertension care to understand the socioeconomic status of the patients and plan their management. Methods: Retrospective study of 68 patients followed-up in the NCD clinic from January to December, 2013. The data have been collected using patients' files included demographic information, numbers of visits, diagnostic tests and medications. The Ministry of Health tariff, the information from the charts and Excel cost analysis was done to discover the average cost per patient and requirement of good care at each stage of hypertension. Results: Of the 68 patients analyzed, 74% were female and 26% were male. Their socioeconomic status was generally very low; most of the patients had zero formal education 37% and 34% patients had only a primary education level; 53% patients were famers owned small pieces of lands which are not considerably productive and 18% patients were unemployed. The cost of providing hypertension healthcare services estimated in monetary values was 53,656,736 Rwf excluding the maintenance cost in financial year 2013. The driving cost of hypertension care delivery was the expenditure on medicines, which were estimated at 9,343,956 Rwf per year. The capital cost was 52% and the recurrent cost was 65% of the total cost of hypertension care. The average costs of hypertension care per patient for each stage per year were 25,431 Rwf for stage one, 45,812 Rwf for stage two and 82,778 Rwf for stage three. Conclusion and implications for translation: The overall control of hypertension with insurance coverage is good at Rwinkwavu District Hospital. Hypertension health care services can be effectively implemented in every district hospital in Rwanda through the NCD program. The cost of providing hypertension health care services information are critically missing in the region, more studies are needed on cost of NCDs health care services and their countries' economy impact as the prevalence increasing rapidly.

Background: Neonatal mortality continues to be a global challenge, particularly in low-and middle-income countries. There is growing work to reduce mortality through improving quality of systems and care, but less is known about sustainability of improvements in the setting post initial implementation. We conducted a 12-month sustainability assessment of All Babies Count (ABC), a district-wide quality improvement project including mentoring and improvement collaborative designed to improve quality and reduce neonatal mortality in two districts in rural Rwanda. Methods:We measured changes in key neonatal process, coverage, and outcome indicators between the completion of ABC implementation and 12 months after the comple tion. In addition, we conducted 4 focus group discussions and 15 individual in-depth interviews with health providers and facility and district leaders to understand factors that influenced sustainability of improvements. We used an inductive, content analytic approach to derive six themes related to the ABC sustainability to explain quantitative results.Findings: Twelve months after the completion of ABC implementation, we found continued improvements in core quality, coverage, and neonatal outcomes. During ABC, the percentage of women with 4 antenatal visits increased from 12% to 30% and remained stable 12 months post-ABC (30%, p = 0.7) with an increase in facilitybased delivery from 92.6% at the end of ABC to 95.8% (p = 0.01) at 12-month post-ABC. During ABC intervention, the 2 districts decreased neonatal mortality from 30.1 to 19.4 deaths per 1,000 live births with maintenance of the lower mortality 12 months post-ABC (19.4 deaths per 1,000 live births, p = 0.7). Leadership buy-in and development of self-reliance encouraging internally generated solutions emerged as key factors to sustain improvements while staff turnover, famine, influx of refugees, and unintended consequences of new national newborn care policies threatened sustainability.

In a suburban hospital in Sydney, salt was accidentally used instead of sugar in the preparation of feeds intended for a number of babies. Five babies were involved in the ensuing epidemic of hypernatraemia; 4 died and one, less severely affected, made a complete recovery. Three of the babies who died were of low birth weight and they presented with symptoms different from those previously described, in that they had diarrhoea, manifested no thirst, and had neither muscular twitchings nor convulsions. Overlapping of the sutures was striking in all cases. Ingestion of an excessive quantity of salt causes hypertonicity of the extracellular fluid which largely explains the disorders involved in hypernatraemia. It is suggested that salt should not be stored in an area where infants' formulae are prepared.